Design of therapeutic TagTile games for children with unilateral spastic cerebral paresis

This research focuses on gaining new insight in design methodology, research techniques and game principles
in the context of tangible games for therapy of children with unilateral Cerebral Paresis (CP).
CP is a disorder of posture and or motor function due to brain damage in the first year of life. In the unilateral
type of CP the right or left side of the body is affected. Although CP is incurable the therapy for CP patients is
effective in increasing their abilities but can be boring because of its repetitive nature. In a previous research
tangible games where created for such therapy and made use of the TagTile (Li, Fontijn and Markopoulos
2008). The TagTile is a system that can localise multiple objects on its surface by using RFID tags. This system
gives feedback with full colour LEDs and by playing sounds. The games created on this TagTile in this previous
research are not implemented in therapy as the proper movements were not triggered enough and
compensating movements were observed often. However, the usage of entertaining interactive tangible games
was seen as promising. A set of games created in this research thus aim to provide entertainment and triggering
the right movements while preventing compensating movements as much as possible.
An iterative process is used to evaluate, improve and validate four created games. Therapists are included in
every step in this process. The target group is analysed with a literature survey, interviews and two short
ethnographic sessions. A new design technique, acting out movements, is used based on a combination of
hands-only scenarios, interaction relabeling and informances. This technique is used to design the first three
games. The fourth game is based on a co-design session with therapists.
The usage of design techniques in this case led to new insights into design methodology. The use of acting out
movement techniques is found to be very useful as the gap between training movements to design is decreased.
In this way compensation could be held to a minimum. In a short design session is of half an hour, it was found
to be impractical to use Systematic Inventive Thinking, a technique using often reoccurring thinking patterns in
design. Interaction relabeling, a technique in which interaction of object are projected to another, is more
suitable for such a session. Using informal tests with friends and family is found to be valuable. Although being
a totally different target group it is a very effective way in finding bugs and improvements. Using several
evaluation sessions and techniques with cooperation of therapists provided useful feedback and triggered
several improvements. The usage of a longer evaluation of seven weeks showed important problems in actual
usage that were not found in previous evaluation sessions.
During the evaluations several criterion to increase fun in games from Malone&Lepper(1987) were
investigated. Children like sounds but especially funny, absurd or extreme sounds. The target group does not
improve completion time when feedback is given on their performance. Children from the target group have no
extraordinary problems with losing a game. An increasing difficulty is not uniformly liked or disliked.
All the games combined train all wanted movements and seem to provide the wanted motivation. In a seven
week evaluation the games were only used in two sessions although earlier evaluations seemed more promising.
The main reasons for not using the games were the effort and time needed to set-up and start the games using
an older version of the TagTile. A newer version was used to create the last game. This game and the newer
version of the TagTile seem promising and can be used in the therapy as this version needs less preparation
time and the game provides motivation and triggers several movements. Lessons on design methodology and
research techniques can be valuable in ongoing research on the TagTile as well as other related research and
design.